Neurofeedback in ADHD

172 Pages·2015·12.46 MB·English

NEUROFEEDBACK
IN ADHD
EDITED BY : Hartmut Heinrich, Ute Strehl, Martijn Arns,
Aribert Rothenberger and Tomas Ros
PUBLISHED IN : Frontiers in Human Neuroscience
Frontiers Copyright Statement About Frontiers
© Copyright 2007-2016 Frontiers
Media SA. All rights reserved. Frontiers is more than just an open-access publisher of scholarly articles: it is a pioneering
All content included on this site, approach to the world of academia, radically improving the way scholarly research
such as text, graphics, logos, button
icons, images, video/audio clips, is managed. The grand vision of Frontiers is a world where all people have an equal
downloads, data compilations and
opportunity to seek, share and generate knowledge. Frontiers provides immediate and
software, is the property of or is
licensed to Frontiers Media SA permanent online open access to all its publications, but this alone is not enough to
(“Frontiers”) or its licensees and/or
realize our grand goals.
subcontractors. The copyright in the
text of individual articles is the property
of their respective authors, subject to Frontiers Journal Series
a license granted to Frontiers.
The compilation of articles constituting The Frontiers Journal Series is a multi-tier and interdisciplinary set of open-access, online
this e-book, wherever published,
as well as the compilation of all other journals, promising a paradigm shift from the current review, selection and dissemination
content on this site, is the exclusive processes in academic publishing. All Frontiers journals are driven by researchers for
property of Frontiers. For the
conditions for downloading and researchers; therefore, they constitute a service to the scholarly community. At the same
copying of e-books from Frontiers’
time, the Frontiers Journal Series operates on a revolutionary invention, the tiered publishing
website, please see the Terms for
Website Use. If purchasing Frontiers system, initially addressing specific communities of scholars, and gradually climbing up to
e-books from other websites
broader public understanding, thus serving the interests of the lay society, too.
or sources, the conditions of the
website concerned apply.
Images and graphics not forming part Dedication to Quality
of user-contributed materials may
not be downloaded or copied Each Frontiers article is a landmark of the highest quality, thanks to genuinely collaborative
without permission.
interactions between authors and review editors, who include some of the world’s best
Individual articles may be downloaded
and reproduced in accordance academicians. Research must be certified by peers before entering a stream of knowledge
with the principles of the CC-BY
that may eventually reach the public - and shape society; therefore, Frontiers only applies
licence subject to any copyright or
other notices. They may not be the most rigorous and unbiased reviews.
re-sold as an e-book.
Frontiers revolutionizes research publishing by freely delivering the most outstanding
As author or other contributor you
grant a CC-BY licence to others to research, evaluated with no bias from both the academic and social point of view.
reproduce your articles, including any
graphics and third-party materials By applying the most advanced information technologies, Frontiers is catapulting scholarly
supplied by you, in accordance with publishing into a new generation.
the Conditions for Website Use and
subject to any copyright notices which
you include in connection with your What are Frontiers Research Topics?
articles and materials.
All copyright, and all rights therein, Frontiers Research Topics are very popular trademarks of the Frontiers Journals Series:
are protected by national and
they are collections of at least ten articles, all centered on a particular subject. With their
international copyright laws.
unique mix of varied contributions from Original Research to Review Articles, Frontiers
The above represents a summary
only. For the full conditions see the Research Topics unify the most influential researchers, the latest key findings and historical
Conditions for Authors and the
Conditions for Website Use. advances in a hot research area! Find out more on how to host your own Frontiers
ISSN 1664-8714 Research Topic or contribute to one as an author by contacting the Frontiers Editorial
ISBN 978-2-88919-722-4
DOI 10.3389/978-2-88919-722-4 Office: [email protected]
Frontiers in Human Neuroscience 1 January 2016 | Neurofeedback in ADHD
NEUROFEEDBACK IN ADHD
Topic Editors:
Hartmut Heinrich, University of Erlangen-Nürnberg, Germany
Ute Strehl, University of Tübingen, Germany
Martijn Arns, Utrecht University, Netherlands
Aribert Rothenberger, University Medical Center Göttingen, Germany
Tomas Ros, University of Geneva, Switzerland
Image by Martijn Arns
EEG-based neurofeedback is used as a treatment approach in attention-deficit / hyperactivity
disorder (ADHD), a clinically and pathophysiologically heterogeneous child psychiatric disorder.
There is increasing evidence for specific effects of neurofeedback when applying ‘standard’ pro-
tocols (slow cortical potentials, theta/beta, sensorimotor rhythm). Knowledge about underlying
mechanisms and moderating variables is increasing. Nevertheless, further well-controlled and
conducted trials are needed to answer open questions concerning optimisation and individu-
alisation of neurofeedback. Further improvements may develop with new methods and tech-
nical developments (e.g., tomographic neurofeedback) and new concepts (integrated ADHD
treatment).
Frontiers in Human Neuroscience 2 January 2016 | Neurofeedback in ADHD
This Frontiers Research Topic comprising 14 articles intends to answer the following questions
concerning neurofeedback in ADHD:
• How efficacious is neurofeedback?
• What is the rationale of applying a certain neurofeedback protocol in ADHD?
• What are central mechanisms and which moderating variables may affect training and treat-
ment outcome?
• How to optimise treatment? What are new developments and which benefits may be expected?
Aspects of learning theory are also stressed dissociating ‘neurofeedback as a treatment’ and
‘neurofeedback as entertainment’. In the Editorial, this crucial aspect is compared to the way you
read (and study) a scientific book versus reading a thriller for leisure. In this respect: Enjoy this
Research Topic, study and apply it in practice, unless you read it for entertainment purposes!
Citation: Heinrich, H., Strehl, U., Arns, M., Rothenberger, A., Ros, T., eds. (2016). Neurofeedback
in ADHD. Lausanne: Frontiers Media. doi: 10.3389/978-2-88919-722-4
Frontiers in Human Neuroscience 3 January 2016 | Neurofeedback in ADHD
Table of Contents
06 Editorial: Neurofeedback in ADHD
Martijn Arns, Hartmut Heinrich, Tomas Ros, Aribert Rothenberger and Ute Strehl
Reviews, theoretical and opinion papers etc.
09 Pathophysiology of ADHD and associated problems—starting points for NF
interventions?
Björn Albrecht, Henrik Uebel-von Sandersleben, Holger Gevensleben and
Aribert Rothenberger
23 Neurofeedback in attention-deficit/hyperactivity disorder – different models,
different ways of application
Holger Gevensleben, Gunther H. Moll, Aribert Rothenberger and Hartmut Heinrich
33 What learning theories can teach us in designing neurofeedback treatments
Ute Strehl
41 Are treatment effects of neurofeedback training in children with ADHD related
to the successful regulation of brain activity? A review on the learning of
regulation of brain activity and a contribution to the discussion on specificity
Agnieszka Zuberer, Daniel Brandeis and Renate Drechsler
56 Tuning pathological brain oscillations with neurofeedback: A systems
neuroscience framework
Tomas Ros, Bernard J. Baars, Ruth A. Lanius and Patrik Vuilleumier
78 What future research should bring to help resolving the debate about the
efficacy of EEG-neurofeedback in children with ADHD
Madelon A. Vollebregt, Martine van Dongen-Boomsma, Dorine Slaats-Willemse and
Jan K. Buitelaar
84 EEG-based local brain activity feedback training—tomographic neurofeedback
Herbert Bauer and Avni Pllana
Methodical studies
90 EEG spectral analysis of attention in ADHD: Implications for neurofeedback
training?
Hartmut Heinrich, Katrin Busch, Petra Studer, Karlheinz Erbe, Gunther H. Moll and
Oliver Kratz
100 Neurofeedback of slow cortical potentials: Neural mechanisms and feasibility of
a placebo-controlled design in healthy adults
Holger Gevensleben, Björn Albrecht, Henry Lütcke, Tibor Auer, Wan Ilma Dewiputri,
Renate Schweizer, Gunther Moll, Hartmut Heinrich and Aribert Rothenberger
Frontiers in Human Neuroscience 4 January 2016 | Neurofeedback in ADHD
113 Slow cortical potential and theta/beta neurofeedback training in adults: Effects
on attentional processes and motor system excitability
Petra Studer, Oliver Kratz, Holger Gevensleben, Aribert Rothenberger, Gunther H. Moll,
Martin Hautzinger and Hartmut Heinrich
Clinical studies
126 EEG neurofeedback treatments in children with ADHD: An updated meta-
analysis of randomized controlled trials
Jean-Arthur Micoulaud-Franchi, Pierre Alexis Geoffroy, Guillaume Fond, Régis Lopez,
Stéphanie Bioulac and Pierre Philip
133 Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep
onset latency
Martijn Arns, Ilse Feddema and J. Leon Kenemans
143 Slow cortical potential neurofeedback and self-management training in
outpatient care for children with ADHD: Study protocol and first preliminary
results of a randomized controlled trial
Hanna Christiansen, Verena Reh, Martin H. Schmidt and Winfried Rief
158 Near-infrared spectroscopy (NIRS) neurofeedback as a treatment for children
with attention deficit hyperactivity disorder (ADHD)—a pilot study
Anna-Maria Marx, Ann-Christine Ehlis, Adrian Furdea, Martin Holtmann,
Tobias Banaschewski, Daniel Brandeis, Aribert Rothenberger, Holger Gevensleben,
Christine M. Freitag, Yvonne Fuchsenberger, Andreas J. Fallgatter and Ute Strehl
Frontiers in Human Neuroscience 5 January 2016 | Neurofeedback in ADHD
EDITORIAL
published:30October2015
doi:10.3389/fnhum.2015.00602
Editorial: Neurofeedback in ADHD
MartijnArns1,2*,HartmutHeinrich3,4,TomasRos5,AribertRothenberger6andUteStrehl7
1ResearchInstituteBrainclinics,Nijmegen,Netherlands,2DepartmentofExperimentalPsychology,UtrechtUniversity,
Utrecht,Netherlands,3DepartmentofChildandAdolescentMentalHealth,UniversityHospitalofErlangen,Erlangen,
Germany,4kbo-Heckscher-Klinikum,München,Germany,5LaboratoryforNeurologyandImagingofCognition,Department
ofNeurosciences,UniversityofGeneva,Geneva,Switzerland,6ChildandAdolescentPsychiatry,UniversityMedicalCenter
Göttingen,Göttingen,Germany,7InstituteofMedicalPsychologyandBehavioralNeurobiology,UniversityofTuebingen
Tuebingen,Germany
Keywords:neurofeedback,ADHD,operantconditioning,classicalconditioning,EEG
Almost a century ago Ivan Pavlov laid the groundwork for what we now know as classical
conditioning.Notlongafterthisfirstdescriptionofclassicalconditioning,andthefirstdescription
of the human EEG by Berger (1929), early observations were made that the human EEG (alpha
blockingresponse)couldbeclassicallyconditioned(DurupandFessard,1935;Loomisetal.,1936).
This alpha blocking response consists of a desynchronization of the dominant alpha activity,
presentduringaneyesclosed(ordark)condition,intoadesynchronizedlowvoltagebetaEEG(also
seeRosetal.,2014,inthisresearchtopic).Moresystematicstudiesdemonstratedthatthealpha
blockingresponsefulfilledallofthePavloviantypesofconditioning(JasperandShagass,1941a)
andcouldnotbeexplainedbysensitization(KnottandHenry,1941).JasperandShagasstooktheir
experimentsonestepfurther,showingthatusingtheseprinciplesofconditioning,subjectscouldbe
taught“voluntarycontrol”overtheiralphablockingresponse,bypairingthelight-onsetnottoan
auditorytone,buttoasub-vocalcommand(“block”;JasperandShagass,1941b).Intheirmostbasic
form, these can be considered the first demonstrations of “neurofeedback” or voluntary control
over the EEG based on basic learning principles. Some years after these initial studies, the first
reportsemployingoperantlearningprinciplestoEEGwerereportedbyKamiya[voluntarycontrol
ofalphapowerandalphapeakfrequency(Kamiya,1968)],McAdametal.[voluntarycontrolofthe
contingentnegativevariation(CNV)orslowcorticalpotential(SCP)(McAdametal.,1966)],and
Sterman (operant conditioning of the so-called sensori-motor rhythm (SMR) in cats, Wyrwicka
andSterman,1968).Interestingly,fromahistoricalperspective,theseEEGparametersarestillthe
focusofintensivestudyinneurofeedbackresearch,asthisresearchtopicnicelyillustrates.
Neurofeedback as a therapeutic intervention has been most comprehensively investigated
for the treatment of attention-deficit/hyperactivity disorder (ADHD), in line with the theme of
this research topic. Leading from a review by Albrecht et al. (2015) on the neurophysiological
Editedandreviewedby: background of this child psychiatric disorder, including its comorbidities, the efficacy of
HaukeR.Heekeren, neurofeedback in the treatment of ADHD is discussed in great detail. The current controversy
FreieUniversitätBerlin,Germany regarding the efficacy of neurofeedback in ADHD is centered on the fundamental question of
*Correspondence: how it should be evaluated: namely, in accordance with the APA guidelines (used to evaluate
MartijnArns psychologicaltreatments),oralongthelinesofdrugtreatments(requiringdouble-blindplacebo
[email protected] controlleddesigns).Intheirperspectivearticle,Vollebregtetal.(2014)reviewthisissueinmore
detail, alongside Gevensleben and colleagues who investigated the feasibility of a double-blind
Received:03June2015 placebocontrolleddesignforSCPneurofeedback(Gevenslebenetal.,2014a).Afurtherinteresting
Accepted:18October2015
approach was undertaken by Micoulaud-Franchi and colleagues, who report an updated meta-
Published:30October2015
analysisofneurofeedbackstudiesinADHD(Micoulaud-Franchietal.,2014).Usingacomparable
Citation: approachastheEuropeanADHDGuidelinesgroup(Sonuga-Barkeetal.,2013),theydemonstrated
ArnsM,HeinrichH,RosT,
significant small to medium effect sizes specifically for inattention, in line with an earlier meta-
RothenbergerAandStrehlU(2015)
analysisthatalsorevealedstrongesteffects for thesame domain(Arnsetal.,2009).Inaddition,
Editorial:NeurofeedbackinADHD.
Front.Hum.Neurosci.9:602. Christiansenandcolleaguesreportpreliminaryresultsofarandomizedcontrolledtrialcomparing
doi:10.3389/fnhum.2015.00602 SCPneurofeedbacktoaself-managementprogram(Christiansenetal.,2014).
FrontiersinHumanNeuroscience|www.frontiersin.org October2015|Volume9 Article602|6
Arnsetal. Editorial:NeurofeedbackinADHD
As is clear from the historical studies mentioned above, andcolleaguesoriginallyreportprotocolspecificeffectsonmotor
neurofeedback is built on the foundations of learning theory. systemexcitability,aswellasP3amplitudesandCNVamplitudes
Therefore, it is crucial to dissociate “neurofeedback as a for Theta/Beta and SCP neurofeedback (Studer et al., 2014).
treatment” from “neurofeedback as entertainment.” The Arnsandcolleaguesfurtherrevealthatalthoughclinicallyboth
“neurofeedbackasentertainment”isanapproachpopularizedby SMR and Theta/Beta neurofeedback have similar effects, only
manymoderndevicessuchastheMattelMindflex(keepaballin for SMR neurofeedback the clinical effects are mediated by
theairusingyourbrainactivity)orconsumer-gradeEEGunits a normalization of sleep-onset latency, suggesting the clinical
suchastheEmotivEpocwhichrunbrain-training“apps.”Inthe effectsofTheta/Betaneurofeedbackaremediatedviaadifferent
same way as there is a difference between “reading a book” for mechanism(Arnsetal.,2014a).
entertainment purposes and “studying a book” to learn how to Although the majority of current research has utilized
apply a specific technique it is no different for neurofeedback. neurofeedback protocols that stem from before the twenty-first
Unfortunately in some clinical studies the goal has been to century, it is also important to look ahead and acknowledge
“entertain”childrenwith“EEG-drivengames,”ratherthanreally new developments. With respect to individualized treatment, it
applying a learning procedure the children could benefit from may be adequate to adapt protocols as suggested by an EEG
foralongerperiod.Inthisrespect,thecontributionsfromStrehl study of attention in Heinrich et al. (2014), and the theoretical
(2014) and Zuberer et al. (2015) are important and valuable framework of Ros et al. (2014). Several contributions also
contributions covering aspects of learning theory. Gevensleben introducenewandpromisingapproachestoneurofeedback,such
and colleagues additionally discuss different neurocognitive as the contribution by Marx and colleagues, who compared
modelsofhowneurofeedbackworks(Gevenslebenetal.,2014b). SCP neurofeedback with Near Infrared Spectroscopy (NIRS)
Ros and colleagues go one step further by offering a firmly neurofeedback in children with ADHD, providing feedback
neurophysiologicalaccount,proposinga“systemsneuroscience from a signal physiologically similar to the fMRI BOLD
framework”fortuningpathologicalbrainoscillations(Rosetal., response (Marx et al., 2014). Also, the perspective article by
2014). Bauer and Pllana provides further insights and opportunities
Up to now, most neurofeedback protocols in the treatment in the application of EEG-based tomographic neurofeedback,
of ADHD (e.g., SMR, Theta/Beta, and SCP Feedback) have theoretically enabling feedback of more focal brain activity
shown comparable effect sizes on ADHD domains such as (BauerandPllana,2014).
inattention, impulsivity and hyperactivity (reviewed in Arns We hope that you will enjoy this research topic, study and
et al., 2014b). In this research topic further indications for apply it in practice, unless you read it only for entertainment
specificity of various neurofeedback protocols emerge. Studer purposes!
REFERENCES
andfeasibilityofaplacebo-controlleddesigninhealthyadults.Front.Hum.
Neurosci.8:990.doi:10.3389/fnhum.2014.00990
Albrecht, B., Uebel-von Sandersleben, H., Gevensleben, H., and Rothenberger, Gevensleben, H., Moll, G. H., Rothenberger, A., and Heinrich, H. (2014b).
A. (2015). Pathophysiology of ADHD, comorbid disorders and associated Neurofeedback in attention-deficit/hyperactivity disorder - different
problems – starting points for Neurofeedback interventions? Front. Hum. models, different ways of application. Front. Hum. Neurosci. 8:846. doi:
Neurosci.9:359.doi:10.3389/fnhum.2015.00359 10.3389/fnhum.2014.00846
Arns,M.,deRidder,S.,Strehl,U.,Breteler,M.,andCoenen,A.(2009).Efficacy Heinrich, H., Busch, K., Studer, P., Erbe, K., Moll, G. H., and Kratz, O.
ofneurofeedbacktreatmentinADHD:theeffectsoninattention,impulsivity (2014). EEG spectral analysis of attention in ADHD: implications for
and hyperactivity: a meta-analysis. Clin. EEG Neurosci. 40, 180–189. doi: neurofeedback training? Front. Hum. Neurosci. 8:611. doi: 10.3389/fnhum.
10.1177/155005940904000311 2014.00611
Arns, M., Feddema, I., and Kenemans, J. L. (2014a). Differential effects of Jasper,H.,andShagass,C.(1941a).Conditioningtheoccipitalalpharhythmin
theta/betaandSMRneurofeedbackinADHDonsleeponsetlatency.Front. man.J.Exp.Psychol.28,373–387.doi:10.1037/h0056139
Hum.Neurosci.8:1019.doi:10.3389/fnhum.2014.01019 Jasper, H., and Shagass, C. (1941b). Conscious time judgments related to
Arns, M., Heinrich, H., and Strehl, U. (2014b). Evaluation of neurofeedback conditionedtimeintervalsandvoluntarycontrolofthealpharhythm.J.Exp.
in ADHD: the long and winding road. Biol. Psychol. 95, 108–115. doi: Psychol.28,503–508.doi:10.1037/h0059201
10.1016/j.biopsycho.2013.11.013 Kamiya,J.(1968).Consciouscontrolofbrainwaves.Psychol.Today1,56–60.
Bauer, H., and Pllana, A. (2014). EEG-based local brain activity feedback Knott,J.R.,andHenry,C.E.(1941).TheConditioningoftheblockingofthealpha
trainingâe”tomographic neurofeedback. Front. Hum. Neurosci. 12:8. doi: rhythmofthehumanElectroencephalogram28,134–144.
10.3389/fnhum.2014.01005 Loomis,A.L.,Harvey,E.N.,andHobart,G.(1936).Electricalpotentialsofthe
Berger, H. (1929). Über das elektroenzephalogramm des menschen. Arch. humanbrain.J.Exp.Psychol.19,249.
PsychiatryNervenkr.87,527–570.doi:10.1007/BF01797193 Marx,A.M.,Ehlis,A.C.,Furdea,A.,Holtmann,M.,Banaschewski,T.,Brandeis,
Christiansen, H., Reh, V., Schmidt, M. H., and Rief, W. (2014). Slow cortical D., et al. (2014). Near-infrared spectroscopy (NIRS) neurofeedback as a
potential neurofeedback and self-management training in outpatient care treatmentforchildrenwithattentiondeficithyperactivitydisorder(ADHD)-a
for children with ADHD: Study protocol and first preliminary results pilotstudy.Front.Hum.Neurosci.8:1038.doi:10.3389/fnhum.2014.01038
of a randomized controlled trial. Front. Hum. Neurosci. 8:943. doi: McAdam, D. W., Irwin, D. A., Rebert, C. S., and Knott, J. R. (1966).
10.3389/fnhum.2014.00943 Conativecontrolofthecontingentnegativevariation.Electroencephalogr.Clin.
Durup, G., and Fessard, A. I. (1935). L’électrencéphalogramme de l’homme. Neurophysiol.21,194–195.
Observationspsycho-physiologiquesrelativesàl’actiondesstimulivisuelset Micoulaud-Franchi,J.A.,Geoffroy,P.A.,Fond,G.,Lopez,R.,Bioulac,S.,and
auditifs.L’annéePsychologique36,1–32.doi:10.3406/psy.1935.30643 Philip,P.(2014).EEGneurofeedbacktreatmentsinchildrenwithADHD:an
Gevensleben,H.,Albrecht,B.,Lütcke,H.,Auer,T.,Dewiputri,W.I.,Schweizer,R., updatedmeta-analysisofrandomizedcontrolledtrials.Front.Hum.Neurosci.
etal.(2014a).Neurofeedbackofslowcorticalpotentials:Neuralmechanisms 8:906.doi:10.3389/fnhum.2014.00906
FrontiersinHumanNeuroscience|www.frontiersin.org October2015|Volume9|Article602| 7
Arnsetal. Editorial:NeurofeedbackinADHD
Ros,T.,J.,Baars,B.,andLanius,R.A.,Vuilleumier,P.(2014).Tuningpathological Wyrwicka, W., and Sterman, M. B. (1968). Instrumental conditioning of
brain oscillations with neurofeedback: a systems neuroscience framework. sensorimotorcortexEEGspindlesinthewakingcat.Physiol.Behav.3,703–707.
Front.Hum.Neurosci.8:1008.doi:10.3389/fnhum.2014.01008 Zuberer, A., Brandeis, D., and Drechsler, R. (2015). Are treatment effects of
Sonuga-Barke,E.J.,Brandeis,D.,Cortese,S.,Daley,D.,Ferrin,M.,Holtmann,M., neurofeedback training in children with ADHD related to the successful
et al. (2013). Nonpharmacological interventions for ADHD: systematic regulationofbrainactivity?Areviewonthelearningofregulationofbrain
review and meta-analyses of randomized controlled trials of dietary activity and a contribution to the discussion on specificity. Front. Hum.
and psychological treatments. Am. J. Psychiatry 170, 275–289. doi: Neurosci.9:135.doi:10.3389/fnhum.2015.00135
10.1176/appi.ajp.2012.12070991
Strehl,U.(2014).Whatlearningtheoriescanteachusindesigningneurofeedback Conflict of Interest Statement: The authors declare that the research was
treatments. Front. Hum. Neurosci. 8:894. doi: 10.3389/fnhum.2014. conductedintheabsenceofanycommercialorfinancialrelationshipsthatcould
00894 beconstruedasapotentialconflictofinterest.
Studer,P.,Kratz,O.,Gevensleben,H.,Rothenberger,A.,Moll,G.H.,Hautzinger,
M.,etal.(2014).Slowcorticalpotentialandtheta/betaneurofeedbacktraining Copyright©2015Arns,Heinrich,Ros,RothenbergerandStrehl.Thisisanopen-
inadults:effectsonattentionalprocessesandmotorsystemexcitability.Front. access article distributed under the terms of the Creative Commons Attribution
Hum.Neurosci.8:555.doi:10.3389/fnhum.2014.00555 License(CCBY).Theuse,distributionorreproductioninotherforumsispermitted,
Vollebregt,M.A.,vanDongen-Boomsma,M.,Slaats-Willemse,D.,andBuitelaar, provided the original author(s) or licensor are credited and that the original
J.K.(2014).Whatfutureresearchshouldbringtohelpresolvingthedebate publicationinthisjournaliscited,inaccordancewithacceptedacademicpractice.
abouttheefficacyofeeg-neurofeedbackinchildrenwithADHD.Front.Hum. Nouse,distributionorreproductionispermittedwhichdoesnotcomplywiththese
Neurosci.8:321.doi:10.3389/fnhum.2014.00321 terms.
FrontiersinHumanNeuroscience|www.frontiersin.org October2015|Volume9|Article602|8
REVIEW
published:24June2015
doi:10.3389/fnhum.2015.00359
Pathophysiology of ADHD and
associated problems—starting points
for NF interventions?
BjörnAlbrecht*,HenrikUebel-vonSandersleben,HolgerGevensleben and
AribertRothenberger
DepartmentofChildandAdolescentPsychiatry,UniversityMedicalCenterGöttingen,Göttingen,Germany
Attention deficit hyperactivity disorder (ADHD) is characterized by severe and
age-inappropriate levels of hyperactivity, impulsivity and inattention. ADHD is a
heterogeneous disorder, and the majority of patients show comorbid or associated
problemsfromotherpsychiatricdisorders.Also,ADHDisassociatedwithcognitiveand
motivational problems as well as resting-state abnormalities, associated with impaired
brainactivityindistinctneuronalnetworks.Thisneedstobeconsideredinamultimodal
treatment, of which neurofeedback (NF) may be a promising component. During NF,
specificbrainactivityisfed-backusingvisualorauditorysignals,allowingtheparticipants
to gain control over these otherwise unaware neuronal processes. NF may be used
to directly improve underlying neuronal deficits, and/or to establish more general self-
regulatory skills that may be used to compensate behavioral difficulties. The current
Editedby: manuscript describes pathophysiological characteristics of ADHD, heterogeneity of
MartijnArns,
ADHD subtypes and gender differences, as well as frequently associated behavioral
ResearchInstituteBrainclinics,
Netherlands problems such as oppositional defiant/conduct or tic disorder. It is discussed how NF
Reviewedby: maybehelpfulasatreatmentapproachwithinthesecontexts.
RoumenKirov,
InstituteofNeurobiology,Bulgarian Keywords:Neurofeedback(NF),ADHD,ODD/CD,ticdisorder,comorbidity,children,neurobiology
AcademyofSciences,Bulgaria
LeonKenemans,
UtrechtUniversity,Netherlands
Introduction
*Correspondence:
BjörnAlbrecht,
DepartmentofChildandAdolescent DifficultieswithInattentionorHyperactivityandImpulsivityasthecoresymptomsofAttention
Psychiatry,UniversityMedicalCenter deficit Hyperactivity disorder (ADHD) are a frequent psychosocial burden. With an early onset
Göttingen,vonSieboldStraße5, duringchildhood,ADHDisoftenpersistingthroughoutlife.Itisaheterogeneousdisorder,anda
37075Göttingen,Germany
challenge to treat. In light of this heterogeneity, the most promising treatment approach should
[email protected]
bemultimodalinnature(Tayloretal.,2004;Swansonetal.,2008).Pharmacologicalinterventions
particularly with stimulants such as methylphenidate and amphetamine sulfate, as well as non-
Received:06October2014
stimulants like Atomoxetine are highly effective in reducing ADHD symptoms (Banaschewski
Accepted:02June2015
Published:24June2015 etal.,2006;Kingetal.,2006),butlong-termeffectivenessisstillquestionable(Molinaetal.,2009;
van de Loo-Neus et al., 2011). In addition, side-effects, non-response and prejudice have raised
Citation:
AlbrechtB,Uebel-vonSandersleben interestinnon-pharmacologicaltreatmentoptions(Sonuga-Barkeetal.,2013;Daleyetal.,2014).
H,GevenslebenHandRothenberger Neurofeedback (NF) as a non-pharmacological intervention for ADHD utilizes cognitive-
A(2015)PathophysiologyofADHD behavioral therapeutic elements to gain access on and practice brain activity (Arns et al.,
andassociatedproblems—starting
2014). In an operant learning paradigm, specific neural activity is quantified by means of
pointsforNFinterventions?
Electro-Encephalography (EEG) or functional Magnetic Resonance Imaging (fMRI) and fed
Front.Hum.Neurosci.9:359.
doi:10.3389/fnhum.2015.00359 back in real time with an easily accessible optical or acoustic signal. In general, the participants
FrontiersinHumanNeuroscience|www.frontiersin.org June2015|Volume9|Article359| 9